Contemporary clinical trials
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Contemp Clin Trials · Jul 2012
ReviewEarly phase drug development for treatment of chronic pain--options for clinical trial and program design.
Due to high prevalence and unmet medical need, chronic pain has become an important area for development of new medicines. Chronic pain disorders are heterogeneous with regard to pathophysiological mechanisms and clinical presentation. While a mechanism-based classification of pain is generally advocated, it is not yet applicable for diagnostic use. ⋯ We have reviewed characteristics of three alternative design options from an early (Phase 2) drug development perspective; enriched enrolment, dose titration and adaptive dosing. The advantages and disadvantages of each type of study design were analyzed and discussed from a clinical development program perspective. It is concluded that these designs can be useful in addressing different types of issues in early development of novel analgesic drugs for chronic pain.
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Contemp Clin Trials · Jul 2012
Randomized Controlled TrialGroup interventions for co-morbid insomnia and osteoarthritis pain in primary care: the lifestyles cluster randomized trial design.
Six weekly sessions of group cognitive-behavioral therapy for insomnia and osteoarthritis pain (CBT-PI), and for osteoarthritis pain alone (CBT-P) were compared to an education only control (EOC). Basic education about pain and sleep was comparable, so EOC controlled for information and group participation. Active interventions differed from EOC in training pain coping skills (CBT-P and CBT-PI) and sleep enhancement techniques (CBT-PI). ⋯ The trial was executed in 6 primary clinics, randomizing 367 participants, with 93.2% of randomized patients attending at least 4 group sessions. Response rates for post-intervention and 9 month assessments were 96.7% and 92.9% respectively. This hybrid efficacy-effectiveness trial design evaluates whether interventions yield specific benefits for clinical and behavioral outcomes relative to an education only control when implemented in a primary care setting.
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Contemp Clin Trials · Jul 2012
Randomized Controlled TrialDesign and rationale for Home Blood Pressure Telemonitoring and Case Management to Control Hypertension (HyperLink): a cluster randomized trial.
Patients with high blood pressure (BP) visit a physician an average of 4 times or more per year in the U.S., yet BP is controlled in fewer than half. Practical, robust and sustainable models are needed to improve BP in patients with uncontrolled hypertension. ⋯ We will test in a real primary care setting whether combining BP telemonitoring and pharmacist case management can achieve and maintain high rates of BP control compared to usual care.
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Contemp Clin Trials · Jul 2012
A Bayesian adaptive design for multi-dose, randomized, placebo-controlled phase I/II trials.
We present a design for a randomized controlled trial (RCT) featuring two simultaneous iterative processes, dose escalation and cohort expansion. In this design, patient enrollment does not need to stop when transitioning from the evaluation of the dose safety and tolerability to the assessment of its efficacy. The cohort expansion used in dose-finding is adaptive, based on the interim comparisons between each dose and placebo. ⋯ Simulation studies also demonstrated that this proposed adaptive design controls the false positive error rate at the specified level and provides adequate statistical power to detect the treatment effect. Compared to the conventional approach, our proposed adaptive design removes ineffective doses, reduces the total sample size, and maintains adequate power for dose-finding. The proposed design has been implemented in an ongoing study and software for trial simulation is available at http://odin.mdacc.tmc.edu/~yuanj/soft.html.
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Contemp Clin Trials · Jul 2012
Randomized Controlled TrialAn online randomised controlled trial to assess the feasibility, acceptability and potential effectiveness of 'Living with Bipolar': a web-based self-management intervention for bipolar disorder: trial design and protocol.
Bipolar Disorder (BD) is a common and severe form of mental illness. Pharmacotherapy is the main treatment offered, but has limited effectiveness, and there is increasing evidence that people with BD respond well to psychological interventions. Inequalities in access to face-to-face psychological interventions mean many people seek support outside of routine health services. ⋯ The results of this trial will inform a definitive trial; and the implementation phase will aim to assess the potential for use within the NHS.